AccountId: 011433970860
ContactId: 8501f5b2-484e-4329-99e2-5a931c4657ff
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 433440 ms
Total Talk Time (AGENT): 260464 ms
Total Talk Time (CUSTOMER): 117574 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/04/8501f5b2-484e-4329-99e2-5a931c4657ff_20250604T15:12_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I have a few questions about our plan. Um, this is the first time I actually calling and finding out what exactly does it cover, and if you can help me out with that.
[AGENT][POSITIVE] Yes, I'll be more than happy to help you with your plan and your benefits. Um, may I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure. My name is [PII] and the phone number is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have your policy number?
[CUSTOMER][NEUTRAL] Uh, there's a group number here 25.
[CUSTOMER][NEUTRAL] 989 and then I have a payer ID.
[AGENT][NEUTRAL] Are you looking at your ID card?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] We're looking for the policy er number.
[CUSTOMER][NEUTRAL] There's 2 of them for inpatient and outpatient.
[AGENT][NEUTRAL] Mhm. The numbers are the same, the ML 7 or 8 at the end is different. I just need the numbers. That's your policy number.
[CUSTOMER][NEUTRAL] Got it. 02361635.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[AGENT][NEUTRAL] OK, here we go, just popped up. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I just need you to verify your date of birth and the mailing address on file.
[CUSTOMER][NEUTRAL] My date of birth is [PII] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. Hold on one moment, I'm just pulling up your policy breakdown so I can get your benefits.
[AGENT][NEUTRAL] So this is your Metlink policy, so we pay towards the copay, deductible and co-insurance of covered charges after your primary insurance. If your primary insurance is not applied to the claim, we as second cannot apply because we're after them.
[AGENT][NEUTRAL] Um, but for like example, if you had to pay like a co-pay at the doctor's office or something, um, or at a hospital, um, the policy you could submit it or
[AGENT][NEUTRAL] You should really give the card to your provider and have them bill, but you do have the option to bill on, you know, file the claim on your own. Um, if you do have to pay the copay when we get it on the back end, we can reimburse you if, if it's owed to you, or if there's something still owed to the provider, we can pay them or both.
[AGENT][NEUTRAL] Um, so
[CUSTOMER][NEUTRAL] OK, so every time I go to my, because I didn't this, I didn't know this worked like that. I, I just went to the doctor a few weeks back and I paid my $35 co-pay. So you guys do, um, take care of those things. How would I submit a claim for that?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So anytime you give your major insurance card, just give APL as well if it's for medical because we're second to them. So I would just, um, you can either call the um provider, the doctor's office, hospital, call them and let them know, hey, I have the secondary insurance, give them the policy number, they may ask you to um like send a copy of the card the front and back, and so that they can get our number and call us to verify the benefits. But yes, as long as the um
[AGENT][NEUTRAL] Policy covers it, you, so your policy has the office treatment rider, so it covers the treatment that's done in the office, but if they charge if they send like a place of service charge, I mean I'm speaking of the coding, then that may be denied because the treatment in the offices was covered on the policy, not where it was done.
[CUSTOMER][NEGATIVE] OK, I didn't know this worked as a secondary. I thought this was just something for like, um, deductibles. That's why I'm calling to find out because I already paid that co-payment. So there's any they don't even have this card on file. I'm not sure if they will reimburse me do I already paid for that. So that's one question and then the next question is.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Well, they wouldn't
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEGATIVE] They wouldn't be the ones to reimburse you. So what I'm saying is, even though you've already had the service that's already been paid for, they're still waiting.
[AGENT][NEUTRAL] They can still put us on their file and if something is still owed to them or if you're receiving bills, they can bill us. So you can either give them, even if it's something from the past, you can give them a call, let them know you have the secondary insurance. We don't have like a timely filing or anything, so there's no deadline. So you technically could go back to [PII] if you wanted to and file and and have them file the claims or you can do it on your own, but, but you, um.
[AGENT][NEUTRAL] Either way, they still can add the information and be billed and bill us.
[CUSTOMER][NEUTRAL] If I do it, if I, if I do it on my own, how does that work?
[AGENT][NEUTRAL] Um, so you can fax it to us, you can mail it, or you can, um, submit the claim on the online service center. You would just need your Medin claim form, which I can email you a copy of that if you need it. Um, that can also be found on our website and um you'll need, you'll always need the explanation of benefits from your primary insurance because we're second to them.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then the itemized billing, the provider's copy, not your not your patient like receipt or bill. It needs to be the provider's copy because it has all the coding, the diagnostic codes and procedure codes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I understand.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] I didn't know this work like this. I've been doing all kinds of procedures, um, X-rays and things like that. I've been paying out of pocket. I have no idea this worked like that. I thought it was just for deductibles. Now, when it comes to uh emergency, like my son's feeling not too well, and um, I might take him, take him to the emergency, I just called the primary insurance and they say he has a $300 co-pay.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Can this cover that?
[AGENT][NEUTRAL] Right, so we pay towards the copay. Now,
[AGENT][NEUTRAL] Everything that we do is on the back end. So if you have to pay a co-pay, you will have to pay that co-pay upfront, and then once we receive the claim, we will see, that's why we ask for the explanation of benefits so we can see what was charged from primary, what you paid, what's left over, so we know what to apply to. So, you always need um those three.
[CUSTOMER][NEUTRAL] OK. So every time I go to any doctor's emergency, I should provide them with this card as well.
[AGENT][NEUTRAL] Mhm. Anytime you give your major medical insurance, give ours with it because we go with that policy.
[CUSTOMER][NEUTRAL] OK dokey.
[CUSTOMER][POSITIVE] OK. OK dokey. Sounds good. Thank you so much. I appreciate it.
[AGENT][POSITIVE] You're very welcome. Was there anything else I can assist you with today?
[CUSTOMER][POSITIVE] No, that'll be all. Thank you.
[AGENT][POSITIVE] Alrighty. Well, thanks for calling APL. I hope you have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you.